Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID-19.
Bachanas PJ , Chun HM , Mehta N , Aberle-Grasse J , Parris K , Sherlock MW , Lloyd S , Zeh C , Makwepa DK , Kapanda ML , Dokubo EK , Bonono L , Balachandra S , Ehui E , Fonjungo P , Nkoso AM , Mazibuko S , Okello VN , Tefera F , Getachew M , Katiku EM , Mulwa A , Asiimwe FM , Tarumbiswa TF , Auld AF , Nyirenda R , Dos Santos De Louvado AP , Gaspar I , Hong SY , Ashipala L , Obanubi C , Ikpeazu A , Musoni C , Yoboka E , Mthethwa S , Pinini Z , Bunga S , Rumunu J , Magesa DJ , Mutayoba B , Nelson LJ , Katureebe C , Agolory S , Mulenga LB , Nyika P , Mugurungi O , Ellerbrock T , Mitruka K . J Int AIDS Soc 2022 25 (11) e26033 INTRODUCTION: The potential disruption in antiretroviral therapy (ART) services in Africa at the start of the COVID-19 pandemic raised concern for increased morbidity and mortality among people living with HIV (PLHIV). We describe HIV treatment trends before and during the pandemic and interventions implemented to mitigate COVID-19 impact among countries supported by the US Centers for Disease Control and Prevention (CDC) through the President's Emergency Plan for AIDS Relief (PEPFAR). METHODS: We analysed quantitative and qualitative data reported by 10,387 PEPFAR-CDC-supported ART sites in 19 African countries between October 2019 and March 2021. Trends in PLHIV on ART, new ART initiations and treatment interruptions were assessed. Viral load coverage (testing of eligible PLHIV) and viral suppression were calculated at select time points. Qualitative data were analysed to summarize facility- and community-based interventions implemented to mitigate COVID-19. RESULTS: The total number of PLHIV on ART increased quarterly from October 2019 (n = 7,540,592) to March 2021 (n = 8,513,572). The adult population (≥15 years) on ART increased by 14.0% (7,005,959-7,983,793), while the paediatric population (<15 years) on ART declined by 2.6% (333,178-324,441). However, the number of new ART initiations dropped between March 2020 and June 2020 by 23.4% for adults and 26.1% for children, with more rapid recovery in adults than children from September 2020 onwards. Viral load coverage increased slightly from April 2020 to March 2021 (75-78%) and viral load suppression increased from October 2019 to March 2021 (91-94%) among adults and children combined. The most reported interventions included multi-month dispensing (MMD) of ART, community service delivery expansion, and technology and virtual platforms use for client engagement and site-level monitoring. MMD of ≥3 months increased from 52% in October 2019 to 78% of PLHIV ≥ age 15 on ART in March 2021. CONCLUSIONS: With an overall increase in the number of people on ART, HIV programmes proved to be resilient, mitigating the impact of COVID-19. However, the decline in the number of children on ART warrants urgent investigation and interventions to prevent further losses experienced during the COVID-19 pandemic and future public health emergencies. |
SARS-CoV-2 viral shedding in vaccinated and unvaccinated persons: A case series.
McCormick DW , Hagan LM , Salvatore PP , Magleby R , Lee C , Sleweon S , Nicolae L , Dixon T , Banta R , Ogle I , Young C , Dusseau C , Ogden C , Browne H , Michael Metz J , Chen MH , Solano MI , Rogers S , Burgin A , Sheth M , Bankamp B , Tamin A , Harcourt JL , Tate JE , Kirking HL . Vaccine 2022 41 (11) 1769-1773 The preclinical time course of SARS-CoV-2 shedding is not well-described. Understanding this time course will help to inform risk of SARS-CoV-2 transmission. During an outbreak in a congregate setting, we collected paired mid-turbinate nasal swabs for antigen testing and reverse-transcription polymerase chain reaction (RT-PCR) every other day from all consenting infected and exposed persons. Among 12 persons tested prospectively before and during SARS-CoV-2 infection, ten of 12 participants (83%) had completed a primary COVID-19 vaccination series prior to the outbreak. We recovered SARS-CoV-2 in viral culture from 9/12 (75%) of participants. All three persons from whom we did not recover SARS-CoV-2 in viral culture had completed their primary vaccination series. We recovered SARS-CoV-2 from viral culture in 6/9 vaccinated persons and before symptom onset in 3/6 symptomatic persons. These findings underscore the need for both non-pharmaceutical interventions and vaccination to mitigate transmission. |
Treatment of hepatitis C in primary health care in the country of Georgia
Dolmazashvili E , Sharvadze L , Abutidze A , Chkhartishvili N , Todua M , Adamia E , Gabunia T , Shadaker S , Gvinjilia L , Arora S , Thornton K , Armstrong PA , Tsertsvadze T . Clin Liver Dis (Hoboken) 2022 20 (5) 175-178 Content available: Audio Recording. |
Use of point-of-care handheld ultrasound for splenomegaly in United States-bound refugees: A novel technology with far-reaching implications
Kummer T , Medley AM , Klosovsky A , Mann E , Mburu P , Ekernas K , Bonass B , Stauffer JC , Walukaga S , Weinberg M , Dunlop SJ , Stauffer WM . Am J Trop Med Hyg 2022 108 (1) 12-14 Ultrasound (US) is an invaluable clinical tool. New point-of-care US technology holds great promise for hard-to-reach and mobile populations such as refugees. The implementation of US in unique and challenging settings has been hindered by cost, fragility of equipment, need for uninterrupted electricity, training, and difficulty in sharing data/image files impeding quality assurance. The recent development of more flexible, durable, high-quality, low-cost, handheld US technology has offered increased potential to address many of these barriers. We describe a pilot program using a new point-of-care US technology to identify and monitor splenomegaly in United States-bound Congolese refugees. This experience and model may hold lessons for planning and development of similar approaches in other hard-to-reach mobile populations. |
Using the food and drug administrations sentinel system for surveillance of TB infection
Walker WL , Schmit KM , Welch EC , Vonnahme LA , Talwar A , Nguyen M , Stojanovic D , Langer AJ , Cocoros NM . Int J Tuberc Lung Dis 2022 26 (12) 1170-1176 BACKGROUND: We examined patterns in care for individuals treated for latent TB infection (LTBI) in the US Food and Drug Administration´s Sentinel System.METHODS: Using administrative claims data, we identified patients who filled standard LTBI treatment prescriptions during 2008-2019. In these cohorts, we assessed LTBI testing, clinical management, and treatment duration.RESULTS: Among 113,338 patients who filled LTBI prescriptions, 80% (90,377) received isoniazid (INH) only, 19% (21,235) rifampin (RIF) only, and 2% (1,726) INH + rifapentine (RPT). By regimen, the proportion of patients with documented prior testing for TBI was 79%, 54%, and 91%, respectively. Median therapy duration was 84 days (IQR 35-84) for the 3-month once-weekly INH + RPT regimen, 60 days (IQR 30-100) for the 6- to 9-month INH regimen, and 30 days (IQR 2-60) for the 4-month RIF regimen.CONCLUSIONS: Among the cohorts, INH-only was the most commonly prescribed LTBI treatment. Most persons who filled a prescription for LTBI treatment did not have evidence of completing recommended treatment duration. These data further support preferential use of shorter-course regimens such as INH + RPT. |
Prehospital stroke care part 1: Emergency medical services and the stroke systems of care
Zachrison KS , Nielsen VM , de la Ossa NP , Madsen TE , Cash RE , Crowe RP , Odom EC , Jauch EC , Adeoye OM , Richards CT . Stroke 2022 54 (4) 1138-1147 Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems. |
Insecticide resistance intensity and efficacy of synergists with pyrethroids in Anopheles gambiae (Diptera: Culicidae) from Southern Togo.
Apetogbo Y , Ahadji-Dabla KM , Soma DD , Amoudji AD , Koffi E , Akagankou KI , Bamogo R , Ngaffo KL , Maiga S , Atcha-Oubou RT , Dorkenoo AM , Vizcaino L , Lenhart A , Diabaté A , Dabiré RK , Ketoh GK . Malar J 2022 21 (1) 353 BACKGROUND: This study was designed to provide insecticide resistance data for decision-making in terms of resistance management plans in Togo. METHODS: The susceptibility status of Anopheles gambiae sensu lato (s.l.) to insecticides used in public health was assessed using the WHO tube test protocol. Pyrethroid resistance intensity bioassays were performed following the CDC bottle test protocol. The activity of detoxification enzymes was tested using the synergists piperonyl butoxide, S.S.S-tributlyphosphorotrithioate and ethacrinic acid. Species-specific identification of An. gambiae s.l. and kdr mutation genotyping were performed using PCR techniques. RESULTS: Local populations of An. gambiae s.l. showed full susceptibility to pirimiphos methyl at Lomé, Kovié, Anié, and Kpèlè Toutou. At Baguida, mortality was 90%, indicating possible resistance to pirimiphos methyl. Resistance was recorded to DDT, bendiocarb, and propoxur at all sites. A high intensity of pyrethroid resistance was recorded and the detoxification enzymes contributing to resistance were oxidases, esterases, and glutathione-s-transferases based on the synergist tests. Anopheles gambiae sensu stricto (s.s.) and Anopheles coluzzii were the main species identified. High kdr L1014F and low kdr L1014S allele frequencies were detected at all localities. CONCLUSION: This study suggests the need to reinforce current insecticide-based malaria control interventions (IRS and LLINs) with complementary tools. |
Spatial, environmental, and individual associations with Anopheles albimanus salivary antigen IgG in Haitian children
Jaramillo-Underwood A , Herman C , Impoinvil D , Sutcliff A , Knipes A , Worrell CM , Fox LM , Desir L , Fayette C , Javel A , Monestime F , Mace KE , Chang MA , Lemoine JF , Won K , Udhayakumar V , Rogier E . Front Cell Infect Microbiol 2022 12 1033917 IgG serology can be utilized to estimate exposure to Anopheline malaria vectors and the Plasmodium species they transmit. A multiplex bead-based assay simultaneously detected IgG to Anopheles albimanus salivary gland extract (SGE) and four Plasmodium falciparum antigens (CSP, LSA-1, PfAMA1, and PfMSP1) in 11,541 children enrolled at 350 schools across Haiti in 2016. Logistic regression estimated odds of an above-median anti-SGE IgG response adjusting for individual- and environmental-level covariates. Spatial analysis detected statistically significant clusters of schools with students having high anti-SGE IgG levels, and spatial interpolation estimated anti-SGE IgG levels in unsampled locations. Boys had 11% (95% CI: 0.81, 0.98) lower odds of high anti-SGE IgG compared to girls, and children seropositive for PfMSP1 had 53% (95% CI: 1.17, 2.00) higher odds compared to PfMSP1 seronegatives. Compared to the lowest elevation, quartiles 2-4 of higher elevation were associated with successively lower odds (0.81, 0.43, and 0.34, respectively) of high anti-SGE IgG. Seven significant clusters of schools were detected in Haiti, while spatially interpolated results provided a comprehensive picture of anti-SGE IgG levels in the study area. Exposure to malaria vectors by IgG serology with SGE is a proxy to approximate vector biting in children and identify risk factors for vector exposure. |
Natural sugar feeding rates of Anopheles mosquitoes collected by different methods in western Kenya
Omondi S , Kosgei J , Agumba S , Polo B , Yalla N , Moshi V , Abong'o B , Ombok M , McDermott DP , Entwistle J , Samuels AM , Ter Kuile FO , Gimnig JE , Ochomo E . Sci Rep 2022 12 (1) 20596 Attractive targeted sugar baits (ATSBs) are a potential vector control tool that exploits the sugar-feeding behaviour of mosquitoes. We evaluated the sugar-feeding behaviour of Anopheles mosquitoes as part of baseline studies for cluster randomised controlled trials of ATSBs. Mosquitoes were collected indoors and outdoors from two villages in western Kenya using prokopack aspirations, malaise tent traps and ultraviolet (UV) light traps. Individual mosquitoes were subjected to the cold anthrone test to assess the presence of sugar. Overall, 15.7% of collected mosquitoes had fed on natural sugar sources. By species and sex, the proportion sugar-fed was 41.3% and 27.7% in male and female Anopheles funestus, 27.2% and 12.8% in male and female An. arabiensis, and 9.7% and 8.3% in male and female An. coustani, respectively. Sugar-feeding was higher in unfed than blood-fed mosquitoes and higher in male than gravid mosquitoes. Anopheles mosquitoes obtained sugar meals from natural sources during all physiological stages, whether they rest indoors or outdoors. These findings offer a potential avenue to exploit for the control of mosquitoes, particularly with the advent of ATSBs, which have been shown to reduce mosquito densities in other regions. |
Systemic toxicity induced by topical application of perfluoroheptanoic acid (PFHpA), perfluorohexanoic acid (PFHxA), and perfluoropentanoic acid (PFPeA) in a murine model.
Weatherly LM , Shane HL , Lukomska E , Baur R , Anderson SE . Food Chem Toxicol 2022 171 113515 Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic structurally diverse chemicals incorporated into industrial and consumer products. PFHpA, PFHxA, and PFPeA are carboxylic PFAS (C7, C6, C5, respectively) labeled as a safer alternative to legacy carboxylic PFAS due to their shorter half-life in animals. Although there is a high potential for dermal exposure, these studies are lacking. The present study conducted analyses of serum chemistries, immune phenotyping, gene expression, and histology to evaluate the systemic toxicity of a sub-chronic 28-day dermal exposure of alternative PFAS (1.25-5% or 31.25-125 mg/kg/dose) in a murine model. Liver weight (% body) significantly increased with PFHpA, PFHxA, and PFPeA exposure and histopathological changes were observed in both the liver and skin. Gene expression changes were observed with PPAR isoforms in the liver and skin along with changes in genes involved in steatosis, fatty acid metabolism, necrosis, and inflammation. These findings, along with significant detection levels in serum and urine, support PFAS-induced liver damage and PPARα, δ, and γ involvement in alternative PFAS systemic toxicity and immunological disruption. This demonstrates that these compounds can be absorbed through the skin and brings into question whether these PFAS are a suitable alternative to legacy PFAS. |
Fecal indicators and antibiotic resistance genes exhibit diurnal trends in the Chattahoochee River: Implications for water quality monitoring.
Nguyen KH , Smith S , Roundtree A , Feistel DJ , Kirby AE , Levy K , Mattioli MC . Front Microbiol 2022 13 1029176 Water bodies that serve as sources of drinking or recreational water are routinely monitored for fecal indicator bacteria (FIB) by state and local agencies. Exceedances of monitoring thresholds set by those agencies signal likely elevated human health risk from exposure, but FIB give little information about the potential source of contamination. To improve our understanding of how within-day variation could impact monitoring data interpretation, we conducted a study at two sites along the Chattahoochee River that varied in their recreational usage and adjacent land-use (natural versus urban), collecting samples every 30 min over one 24-h period. We assayed for three types of microbial indicators: FIB (total coliforms and Escherichia coli); human fecal-associated microbial source tracking (MST) markers (crAssphage and HF183/BacR287); and a suite of clinically relevant antibiotic resistance genes (ARGs; blaCTX-M, blaCMY, MCR, KPC, VIM, NDM) and a gene associated with antibiotic resistance (intl1). Mean levels of FIB and clinically relevant ARGs (blaCMY and KPC) were similar across sites, while MST markers and intI1 occurred at higher mean levels at the natural site. The human-associated MST markers positively correlated with antibiotic resistant-associated genes at both sites, but no consistent associations were detected between culturable FIB and any molecular markers. For all microbial indicators, generalized additive mixed models were used to examine diurnal variability and whether this variability was associated with environmental factors (water temperature, turbidity, pH, and sunlight). We found that FIB peaked during morning and early afternoon hours and were not associated with environmental factors. With the exception of HF183/BacR287 at the urban site, molecular MST markers and intI1 exhibited diurnal variability, and water temperature, pH, and turbidity were significantly associated with this variability. For blaCMY and KPC, diurnal variability was present but was not correlated with environmental factors. These results suggest that differences in land use (natural or urban) both adjacent and upstream may impact overall levels of microbial contamination. Monitoring agencies should consider matching sample collection times with peak levels of target microbial indicators, which would be in the morning or early afternoon for the fecal associated indicators. Measuring multiple microbial indicators can lead to clearer interpretations of human health risk associated with exposure to contaminated water. |
Childhood exposures to environmental chemicals and neurodevelopmental outcomes in congenital heart disease
Gaynor JW , Burnham NB , Ittenbach RF , Gerdes M , Bernbaum JC , Zackai E , Licht DJ , Russell WW , Zullo EE , Miller T , Hakonarson H , Clarke KA , Jarvik GP , Calafat AM , Bradman A , Bellinger DC , Henretig FM , Coker ES . PLoS One 2022 17 (11) e0277611 BACKGROUND: Children with congenital heart defects have an increased risk of neurodevelopmental disability. The impact of environmental chemical exposures during daily life on neurodevelopmental outcomes in toddlers with congenital heart defects is unknown. METHODS: This prospective study investigated the impacts of early childhood exposure to mixtures of environmental chemicals on neurodevelopmental outcomes after cardiac surgery. Outcomes were assessed at 18 months of age using The Bayley Scales of Infant and Toddler Development-III. Urinary concentrations of exposure biomarkers of pesticides, phenols, parabens, and phthalates, and blood levels of lead, mercury, and nicotine were measured at the same time point. Bayesian profile regression and weighted quantile sum regression were utilized to assess associations between mixtures of biomarkers and neurodevelopmental scores. RESULTS: One-hundred and forty infants were enrolled, and 110 (79%) returned at 18 months of age. Six biomarker exposure clusters were identified from the Bayesian profile regression analysis; and the pattern was driven by 15 of the 30 biomarkers, most notably 13 phthalate biomarkers. Children in the highest exposure cluster had significantly lower adjusted language scores by -9.41 points (95%CI: -17.2, -1.7) and adjusted motor scores by -4.9 points (-9.5, -0.4) compared to the lowest exposure. Weighted quantile sum regression modeling for the overall exposure-response relationship showed a significantly lower adjusted motor score ( = -2.8 points [2.5th and 97.5th percentile: -6.0, -0.6]). The weighted quantile sum regression index weights for several phthalates, one paraben, and one phenol suggest their relevance for poorer neurodevelopmental outcomes. CONCLUSIONS: Like other children, infants with congenital heart defects are exposed to complex mixtures of environmental chemicals in daily life. Higher exposure biomarker concentrations were associated with significantly worse performance for language and motor skills in this population. |
Public health applications of historical smoke forecasts: An evaluation of archived BlueSky data for the coterminous United States, 20152018
Michael R , Mirabelli MC , Vaidyanathan A . Comput Geosci 2023 171 Background: Wildfires are increasing in magnitude, frequency, and severity. Populations in the wildland-urban interface and in downwind communities are at increased risk of exposure to elevated concentrations of fine particulate matter (PM2.5) and other harmful components of wildfire smoke. We conducted this analysis to evaluate the use of modeled predictions of wildfire smoke to create county-level measures of smoke exposure for public health research and surveillance. Methods: We evaluated four years (20152018) of grid-based North American Mesoscale (NAM)-derived PM2.5 forecasts from the U.S. Forest Service BlueSky modeling framework with monitoring data from the Environmental Protection Agency Air Quality System (AQS), the Interagency Monitoring of Protected Visual Environments (IMPROVE), the Western Regional Climate Center (WRCC), and the Interagency Real Time Smoke Monitoring (AIRSIS) programs. To assess relationships between model-derived estimates and monitor-based observations, we assessed Spearman's correlations by spatial (i.e., county, level of urbanization, states in the western United States impacted by major wildfires, and climate regions) and temporal (i.e., month and wildfire activity periods) characteristics. We then generated county-level smoke estimates and examined spatial and temporal patterns in total and person-days of smoke exposure. Results: Across all counties in the coterminous United States and for all days, the correlation between county-level model- and monitor-derived PM2.5 estimates was 0.14 (p < 0.001). Correlations were stronger using data from temporary monitors and for areas and days impacted by high wildfire smoke, especially in the western United States. Correlations between county-level model- and monitor-derived estimates in non-metropolitan counties, and at higher concentrations ranged from 0.25 to 0.54 (p < 0.001). Conclusions: In general, public health practitioners and health researchers need to consider the pros and cons associated with modeled data products for conducting health analyses. Our results support the use of model-derived smoke estimates to identify communities impacted by heavy smoke events, especially during emergency response and for communities located near wildfire episodes. 2022 |
Using semistructured telephone interviews to collect qualitative data from people with HIV who are not in medical care: Implementation study
Padilla M , Gutierrez M , Fagan J . JMIR Res Protoc 2022 11 (11) e40041 BACKGROUND: The Medical Monitoring Qualitative (MMP-Qual) Project was designed to collect qualitative data from people with HIV not engaged in medical care that would complement quantitative data collected by the Medical Monitoring Project (MMP)-a national surveillance system-and inform the MMP's recruitment and data collection methods. OBJECTIVE: Our objectives were to describe the methodology of this project, reflect on the challenges and lessons learned from conducting qualitative telephone interviews at a national level, and describe how we used and plan to use the qualitative data to evaluate our recruitment procedures and quantitative data collection instrument as well as knowledge of HIV care engagement. METHODS: We used stratified purposive sampling to identify and recruit participants who had participated in the structured MMP interview into the MMP-Qual Project. To be eligible, participants must have had an HIV diagnosis, be aged ≥18 years, have lived in an MMP jurisdiction, and have not been engaged in HIV medical care. From August 1, 2018, to May 31, 2019, we conducted semistructured telephone interviews with 36 people with HIV across the United States about several topics (eg, facilitators and barriers to care and experience with surveys). Four trained interviewers conducted semistructured 60-minute telephone interviews with 36 participants. Data collection lasted from August 1, 2018, to May 31, 2019. RESULTS: From 2018 to 2019, 113 people were eligible to participate in the MMP-Qual Project. Of the people recruited, 28% (22/79) refused to participate. Of those who agreed to participate, 63% (36/57) were interviewed, and 37% (21/57) were no-shows. Of the 34 participants for whom we had complete data, 15 (44%) were aged ≥50 years, 26 (76%) identified as male, 22 (65%) were Black or African American, and 12 (35%) lived in the Southern United States. CONCLUSIONS: We learned that it is possible to obtain rich qualitative data from people with HIV who are not in care via telephone interviews and that this mode might be conducive to talking about sensitive topics. We also learned the importance of flexibility, communication, and coordination because we relied on health department staff to perform recruitment and had difficulty implementing our original sampling strategy. We hope that other projects will learn from our experience conducting qualitative telephone interviews with people with HIV on a national level. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/40041. |
Rapid implementation of high-frequency wastewater surveillance of SARS-CoV-2
Holst MM , Person J , Jennings W , Welsh RM , Focazio MJ , Bradley PM , Schill WB , Kirby AE , Marsh ZA . ACS ES T Water 2022 2 (11) 2201-2210 There have been over 507 million cases of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in 6 million deaths globally. Wastewater surveillance has emerged as a valuable tool in understanding SARS-CoV-2 burden in communities. The National Wastewater Surveillance System (NWSS) partnered with the United States Geological Survey (USGS) to implement a high-frequency sampling program. This report describes basic surveillance and sampling statistics as well as a comparison of SARS-CoV-2 trends between high-frequency sampling 3-5 times per week, referred to as USGS samples, and routine sampling 1-2 times per week, referred to as NWSS samples. USGS samples provided a more nuanced impression of the changes in wastewater trends, which could be important in emergency response situations. Despite the rapid implementation time frame, USGS samples had similar data quality and testing turnaround times as NWSS samples. Ensuring there is a reliable sample collection and testing plan before an emergency arises will aid in the rapid implementation of a high-frequency sampling approach. High-frequency sampling requires a constant flow of information and supplies throughout sample collection, testing, analysis, and data sharing. High-frequency sampling may be a useful approach for increased resolution of disease trends in emergency response. © 2022 American Chemical Society. All rights reserved. |
Correspondence on "Cost-effectiveness of exome and genome sequencing for children with rare and undiagnosed conditions" by Lavelle et al.
Grosse SD , Gudgeon JM . Genet Med 2022 24 (12) 2595-2596 Lavelle et al1 have published an important modeling assessment of exome sequencing (ES) and genome sequencing (GS) in 2 types of pediatric patients. They concluded that first-line rapid GS (rGS) is likely to be cost-effective for diagnosing critically ill babies with suspected genetic disorders relative to the standard of diagnostic care, defined as including other types of genetic and laboratory tests, which is consistent with other studies.2,3 Lavelle et al1 also concluded that first-line rGS dominates (costs less and is at least as effective) alternative testing strategies, including first-line rapid ES (rES). We believe that it is premature to conclude that rGS dominates rES for 2 primary reasons. First, the relative difference between rES and rGS testing costs may be substantially greater than the 14% differential assumed in their model (ie, $10,320 [$3600] for trio rES vs $12,000 [$3000] for trio rGS based on 2019 laboratory prices).1 Second, the relative difference in diagnostic yield of rES and rGS may be less than the roughly 25% assumed in their model.1 Based on published estimates, rES in critically ill babies may be, at least in some settings, similar in effectiveness while costing substantially less than rGS.2 |
Genome Sequences of Hemolytic and Nonhemolytic Listeria innocua Strains from Human, Food, and Environmental Sources.
McIntosh T , Kucerova Z , Katz LS , Lilley CM , Rowe LA , Unoarumhi Y , Batra D , Burnett E , Smikle M , Lee C . Microbiol Resour Announc 2022 11 (12) e0072322 This report describes genome sequences for nine Listeria innocua strains that varied in hemolytic phenotypes on sheep blood agar. All strains were sequenced using Pacific Biosciences (PacBio) single-molecule real-time (SMRT) chemistry; overall, the average read length of these sequences was 2,869,880 bp, with an average GC content of 37%. |
Identification of Human Monkeypox Virus Genome Deletions That Impact Diagnostic Assays.
Garrigues JM , Hemarajata P , Lucero B , Alarcón J , Ransohoff H , Marutani AN , Kim M , Marlowe EM , Realegeno SE , Kagan RM , Montero CI , Chen NFG , Grubaugh ND , Vogels CBF , Green NM . J Clin Microbiol 2022 60 (12) e0165522 In August 2022, the Los Angeles County Department of Public Health initiated an investigation into human monkeypox virus (MPXV) cases with unusual results from a multiplex laboratory-developed test used by Quest Diagnostics, which is based on the CDC nonvariola Orthopoxvirus (NVO) (1) and MPXV clade II (MPXV-WA) (2) real-time PCR assays. These specimens returned NVO–positive and either MPXV-WA–negative or positive results with high Ct values, which differ from the strong dual-positive results typically associated with the current outbreak. Since these patients met the case definition for probable human MPXV infection, (3) these discordant results were presumed to be due to a mutation affecting the performance of the MPXV-WA assay. |
Refusal of daily oral PrEP: Implementation considerations and reported likelihood of using various HIV prophylaxis products in a diverse sample of MSM
Mansergh G , Kota KK , Carnes N , Gelaude D . J Acquir Immune Defic Syndr 2023 92 (3) 212-216 BACKGROUND: An important subgroup of gay, bisexual, and other men who have sex with men (MSM) with behavioral indications refuse daily oral pre-exposure prophylaxis (PrEP) when recommended by a provider. Emerging HIV prophylaxis products (eg, injectable, event-driven) offer more options to MSM who refuse daily PrEP. In this article, we assess reasons for refusal and likelihood to use various products among MSM who refused PrEP. METHODS: MSM who reported anal sex without condoms or PrEP and refused daily oral PrEP in the past 6 months were recruited through clinics, community venues, and online in Atlanta, Chicago, and Raleigh-Durham. Men were asked their main reason for recently refusing daily PrEP and likelihood of using various PrEP options in the future. Bivariate and multivariable regression models were used to estimate associations. RESULTS: MSM (n = 93; 70% Black, 48% age 18-29 years) reported their main reason for refusing daily PrEP were potential side effects (35%), a daily pill regimen (22%), and not having enough information (18%). Reported likelihood of using PrEP products was 58% for penile gel, 54% for event-driven oral, 52% for injectable, and 50% for daily PrEP. MSM who reported daily regimen as the main reason for refusing PrEP had greater odds of likelihood to use an injectable [adjusted odds ratio (AOR) = 5.21, 95% confidence interval (CI): 1.32 to 20.52]. Younger men (18-29 vs 30+ years) had greater odds of likelihood to use condoms (AOR = 3.40, 95% CI: 1.15 to 10.04) and daily PrEP (AOR = 2.76, 95% CI: 1.06 to 7.16); there were no product preference differences by race. CONCLUSION: Most men who refused daily PrEP indicated likelihood of using some form of PrEP in the future. |
Economic burden of skin cancer treatment in the USA: an analysis of the Medical Expenditure Panel Survey Data, 2012-2018
Kao SZ , Ekwueme DU , Holman DM , Rim SH , Thomas CC , Saraiya M . Cancer Causes Control 2022 34 (3) 205-212 PURPOSE: We report the prevalence and economic cost of skin cancer treatment compared to other cancers overall in the USA from 2012 to 2018. METHODS: Using the Medical Expenditure Panel Survey full-year consolidated data files and associated medical conditions and medical events files, we estimate the prevalence, total costs, and per-person costs of treatment for melanoma and non-melanoma skin cancer among adults aged ≥ 18 years in the USA. To understand the changes in treatment prevalence and treatment costs of skin cancer in the context of overall cancer treatment, we also estimate the prevalence, total costs, and per-person costs of treatment for non-skin cancer among US adults. RESULTS: During 2012-15 and 2016-18, the average annual number of adults treated for any skin cancer was 5.8 (95% CI: 5.2, 6.4) and 6.1 (95% CI: 5.6, 6.6) million, respectively, while the average annual number of adults treated for non-skin cancers rose from 10.8 (95% CI: 10.0, 11.5) to 11.9 (95% CI: 11.2, 12.6) million, respectively. The overall estimated annual costs rose from $8.0 (in 2012-2015) to $8.9 billion (in 2016-18) for skin cancer treatment and $70.2 to $79.4 billion respectively for non-skin cancer treatment. CONCLUSION: The prevalence and economic cost of skin cancer treatment modestly increased in recent years. Given the substantial cost of skin cancer treatment, continued public health attention to implementing evidence-based sun-safety interventions to reduce skin cancer risk may help prevent skin cancer and the associated treatment costs. |
Implementing tuberculosis patient cost surveys in resource-constrained settings: lessons from Tanzania
Kilale AM , Makasi C , Majaha M , Manga CD , Haule S , Hilary P , Kimbute O , Kitua S , Jani B , Range N , Ngowi B , Nkiligi E , Matechi E , Muhandiki W , Mahamba V , Mutayoba B , Ershova J . BMC Public Health 2022 22 (1) 2187 Tuberculosis (TB) disproportionally affects persons and families who are economically and socially disadvantaged. Therefore, a patient cost survey was conducted in Tanzania to evaluate the costs incurred by patients and their households before and after the diagnosis of TB. It was the first survey in Tanzania to ascertain baseline information and experience for subsequent surveys. This paper aims to share the experience encountered during the survey to ensure a standardized approach and elimination of potential barriers for the implementation of future surveys. A total of 777 TB patients from 30 clusters selected based on probability proportional to the size were interviewed during the study period. As the sample size was calculated based on notification data from the previous year, some health facilities experienced an inadequate number of TB patients during the study to meet the allocated cluster size for the survey. Most facilities had poor recording and recordkeeping in TB registers where deaths were not registered, and some patients had not been assigned district identification numbers. Fixed days for TB drug refills in health facilities affected the routine implementation of the survey as the interviews were conducted when patients visited the facility to pick up the drugs. Tablets used to collect data failed to capture the geographic location in some areas. The households of TB patients lost to follow-up and those who had died during TB treatment were not included in the survey. When planning and preparing for patient costs surveys, it is important to consider unforeseen factors which may affect planned activities and findings. During the survey in Tanzania, the identified challenges included survey logistics, communications, patient enrollment, and data management issues. To improve the quality of the findings of future surveys, it may be reasonable to revise survey procedures to include households of TB patients who were lost to follow-up and those who died during TB treatment; the households of such patients may have incurred higher direct and indirect costs than households whose patient was cured as a result of receiving TB treatment. |
Association of area-based socioeconomic measures with tuberculosis incidence in California
Bakhsh Y , Readhead A , Flood J , Barry P . J Immigr Minor Health 2022 1-10 We assessed the association of area-based socio-economic status (SES) measures with tuberculosis (TB) incidence in California. We used TB disease data for 2012-2016 (n=9901), population estimates, and SES measures to calculate incidence rates, rate ratios, and 95% confidence intervals (95% CI) by SES and birth country. SES was measured by census tract and was categorized by quartiles for education, crowding, and the California Healthy Places Index (HPI)and by specific cutoffs for poverty. The lowest SES areas defined by education, crowding, poverty, and HPI had 39%, 40%, 41%, and 33% of TB cases respectively. SES level was inversely associated with TB incidence across all SES measures and birth countries. TB rates were 3.2 (95% CI 3.0-3.4), 2.1 (95% CI 1.9-2.2), 3.6 (95% CI 3.3-3.8), and 2.0 (95% CI 1.9-2.1) times higher in lowest SES areas vs. highest SES areas as defined by education, crowding, poverty and HPI respectively. Area-based SES measures are associated with TB incidence in California. This information could inform TB prevention efforts in terms of materials, partnerships, and prioritization. |
Health departments' role in addressing social determinants of health in collaboration with multisector community partnerships
Emery KJ , Durocher B , Arena LC , Glasgow L , Bayer EM , Plescia M , Holtgrave PL , Hacker K . J Public Health Manag Pract 2023 29 (1) 51-55 Multisector community partnerships (MCPs) are key component of the public health strategy for addressing social determinants of health (SDOH) and promoting health equity. Governmental public health agencies are often members or leaders of MCPs, but few studies have examined the role of health departments in supporting MCPs' SDOH initiatives. We engaged 42 established MCPs in a rapid retrospective evaluation to better understand how MCPs' SDOH initiatives contribute to community changes that promote healthy living and improved health outcomes. As part of this work, we gained insights into how health departments support MCPs' SDOH initiatives, as well as opportunities for enhanced collaboration. Results indicate that health departments can support MCPs' SDOH initiatives through the provision of funding and technical assistance, data sharing, and connecting community organizations with shared missions, for example. Findings can be used to inform the development of funding opportunities and technical assistance for MCPs and health department partners. |
Association between county-level food retail and socioeconomic environment and nutritional quality of household food purchases, 2015
Ghazaryan A , Carlson AC , Rhone A , Roy K . J Acad Nutr Diet 2022 Background: About 40 million Americans do not have easy access to affordable nutritious foods. Healthier foods are less likely to be available to those living in rural and/or lower-income communities. Objective: The objective of this study was to analyze the association between nutritional quality of household food purchases and county-level food retail environment; county-level demographic, health, and socioeconomic indicators; and household composition, demographic characteristics, and socioeconomic characteristics. Design: This study is a secondary analysis of the 2015 Information Resources Inc Consumer Network panel; Purchase-to-Plate Crosswalk, which links US Department of Agriculture nutrition databases to Information Resources Inc scanner data; County Health Rankings; and the Food Environment Atlas data. Participants and settings: A total of 63,285 households, representative of the contiguous US population, consistently provided food purchase scanner data from retail stores throughout 2015. Main outcome measures: Nutritional quality of retail food purchases was assessed using the Healthy Eating Index 2015 (HEI-2015). Statistical analysis: Multivariate linear regression analysis was used to simultaneously test the relationship between the main outcome and household-level demographic and socioeconomic characteristics as well as the county-level demographic, health, socioeconomic, and retail food environment. Results: Household heads who had higher education and households with higher incomes purchased food of better nutritional quality (ie, higher HEI-2015 scores). Also, the association between retail food purchase HEI-2015 scores and the food environment was weak. Higher density of convenience stores was associated with lower retail food purchase nutritional quality for higher-income households and households living in urban counties, whereas low-income households in counties with higher specialty (including ethnic) store density purchased higher nutritional quality food. Both in the full sample and when stratified by household income or county rural vs urban status, no association was found between grocery store, supercenters, fast-food outlets, and full-service restaurant densities and retail food purchase HEI-2015 scores. HEI-2015 scores were negatively correlated with the county average number of mental health days for higher income and urban households. Conclusions: The study findings suggest that availability of healthier food alone may not improve healthfulness of retail food purchases. Future studies examining the influence of demand-side factors/interventions, such as habits, cultural preferences, nutrition education, and cost/affordability, on household purchasing patterns could provide complementary evidence to inform effective intervention strategies. 2022 Academy of Nutrition and Dietetics |
Getting further faster: Illuminating opportunities for health departments to support community-driven social determinants of health interventions
Hacker K , Glasgow L , Bayer EM , Holtgrave P . J Public Health Manag Pract 2023 29 (1) 105-107 Since 1980, the Healthy People initiative has developed measurable 10-year objectives to guide and evaluate our nation's efforts to improve the health and well-being of all people. Healthy People 2030 includes an overarching goal that focuses on social determinants of health (SDOH): “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”1 As we recover from an unprecedented pandemic, we have an opportunity to leverage recent investments in the US public health system to advance this national SDOH goal. Multisector community partnerships (MCPs) are a key component of the public health approach to addressing SDOH and promoting health equity.2 In 2020, the Centers for Disease Control and Prevention's (CDC's) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), National Association of County and City Health Officials (NACCHO), and Association of State and Territorial Health Officials (ASTHO) launched the Improving SDOH—Getting Further Faster (GFF) initiative, partnering with 42 established MCPs and RTI International to rapidly generate practice-based evidence that could inform and strengthen future community-driven SDOH interventions.3 GFF focuses on 5 SDOH domains with links to chronic disease: (1) built environment, (2) community-clinical linkages, (3) food and nutrition security, (4) social connectedness, and (5) tobacco-free policies. This column provides a progress update on the GFF initiative, including a brief description of ongoing work to illuminate opportunities for health departments and health care systems to support community-driven SDOH interventions. |
Development and evaluation of The Ally Sexual And Gender Minority Diversity And Inclusion Training at the Centers for Disease Control and Prevention
Thomas EV , Jennings MA , Kidder DP , Fechter-Leggett ED , Bautista GJ , Johns MM . J Public Health Manag Pract 2023 29 (1) 56-63 CONTEXT: The Centers for Disease Control and Prevention (CDC) developed a workforce training on sexual and gender minorities (SGMs). OBJECTIVE: This article describes the evaluation of the training. DESIGN: Participants completed pre- and posttest surveys. After the pilot evaluation, some improvements were made to the curriculum and to the pre- and posttest questionnaires. Participants in subsequent (implementation) training were similarly asked to complete pre- and posttest questionnaires. SETTING: CDC. PARTICIPANTS: CDC staff. MAIN OUTCOME MEASURES: Participants' knowledge, ally identity, and perceptions of SGMs. RESULTS: Pilot and implementation training data showed increases in participant knowledge of 44% and 49%, respectively, increases in ally identity of 11% and 14%, respectively, and increases in positive perceptions of SGM of 25% and 31%, respectively. CONCLUSION: These results suggest that the CDC Ally Training may be a useful tool for improving staff knowledge and perceptions of SGM people. |
Impact of SARS-CoV-2 vaccination of children ages 5-11 years on COVID-19 disease burden and resilience to new variants in the United States, November 2021-March 2022: A multi-model study.
Borchering RK , Mullany LC , Howerton E , Chinazzi M , Smith CP , Qin M , Reich NG , Contamin L , Levander J , Kerr J , Espino J , Hochheiser H , Lovett K , Kinsey M , Tallaksen K , Wilson S , Shin L , Lemaitre JC , Hulse JD , Kaminsky J , Lee EC , Hill AL , Davis JT , Mu K , Xiong X , Pastore YPiontti A , Vespignani A , Srivastava A , Porebski P , Venkatramanan S , Adiga A , Lewis B , Klahn B , Outten J , Hurt B , Chen J , Mortveit H , Wilson A , Marathe M , Hoops S , Bhattacharya P , Machi D , Chen S , Paul R , Janies D , Thill JC , Galanti M , Yamana T , Pei S , Shaman J , España G , Cavany S , Moore S , Perkins A , Healy JM , Slayton RB , Johansson MA , Biggerstaff M , Shea K , Truelove SA , Runge MC , Viboud C , Lessler J . Lancet Reg Health Am 2023 17 100398 BACKGROUND: The COVID-19 Scenario Modeling Hub convened nine modeling teams to project the impact of expanding SARS-CoV-2 vaccination to children aged 5-11 years on COVID-19 burden and resilience against variant strains. METHODS: Teams contributed state- and national-level weekly projections of cases, hospitalizations, and deaths in the United States from September 12, 2021 to March 12, 2022. Four scenarios covered all combinations of 1) vaccination (or not) of children aged 5-11 years (starting November 1, 2021), and 2) emergence (or not) of a variant more transmissible than the Delta variant (emerging November 15, 2021). Individual team projections were linearly pooled. The effect of childhood vaccination on overall and age-specific outcomes was estimated using meta-analyses. FINDINGS: Assuming that a new variant would not emerge, all-age COVID-19 outcomes were projected to decrease nationally through mid-March 2022. In this setting, vaccination of children 5-11 years old was associated with reductions in projections for all-age cumulative cases (7.2%, mean incidence ratio [IR] 0.928, 95% confidence interval [CI] 0.880-0.977), hospitalizations (8.7%, mean IR 0.913, 95% CI 0.834-0.992), and deaths (9.2%, mean IR 0.908, 95% CI 0.797-1.020) compared with scenarios without childhood vaccination. Vaccine benefits increased for scenarios including a hypothesized more transmissible variant, assuming similar vaccine effectiveness. Projected relative reductions in cumulative outcomes were larger for children than for the entire population. State-level variation was observed. INTERPRETATION: Given the scenario assumptions (defined before the emergence of Omicron), expanding vaccination to children 5-11 years old would provide measurable direct benefits, as well as indirect benefits to the all-age U.S. population, including resilience to more transmissible variants. FUNDING: Various (see acknowledgments). |
COVID-19 SeroHub, an online repository of SARS-CoV-2 seroprevalence studies in the United States.
Freedman ND , Brown L , Newman LM , Jones JM , Benoit TJ , Averhoff F , Bu X , Bayrak K , Lu A , Coffey B , Jackson L , Chanock SJ , Kerlavage AR . Sci Data 2022 9 (1) 727 Seroprevalence studies provide useful information about the proportion of the population either vaccinated against SARS-CoV-2, previously infected with the virus, or both. Numerous studies have been conducted in the United States, but differ substantially by dates of enrollment, target population, geographic location, age distribution, and assays used. This can make it challenging to identify and synthesize available seroprevalence data by geographic region or to compare infection-induced versus combined infection- and vaccination-induced seroprevalence. To facilitate public access and understanding, the National Institutes of Health and the Centers for Disease Control and Prevention developed the COVID-19 Seroprevalence Studies Hub (COVID-19 SeroHub, https://covid19serohub.nih.gov/ ), a data repository in which seroprevalence studies are systematically identified, extracted using a standard format, and summarized through an interactive interface. Within COVID-19 SeroHub, users can explore and download data from 178 studies as of September 1, 2022. Tools allow users to filter results and visualize trends over time, geography, population, age, and antigen target. Because COVID-19 remains an ongoing pandemic, we will continue to identify and include future studies. |
Structural characterization of protective non-neutralizing antibodies targeting Crimean-Congo hemorrhagic fever virus
Durie IA , Tehrani ZR , Karaaslan E , Sorvillo TE , McGuire J , Golden JW , Welch SR , Kainulainen MH , Harmon JR , Mousa JJ , Gonzalez D , Enos S , Koksal I , Yilmaz G , Karakoc HN , Hamidi S , Albay C , Spengler JR , Spiropoulou CF , Garrison AR , Sajadi MM , Bergeron É , Pegan SD . Nat Commun 2022 13 (1) 7298 Crimean-Congo Hemorrhagic Fever Virus (CCHFV) causes a life-threatening disease with up to a 40% mortality rate. With no approved medical countermeasures, CCHFV is considered a public health priority agent. The non-neutralizing mouse monoclonal antibody (mAb) 13G8 targets CCHFV glycoprotein GP38 and protects mice from lethal CCHFV challenge when administered prophylactically or therapeutically. Here, we reveal the structures of GP38 bound with a human chimeric 13G8 mAb and a newly isolated CC5-17 mAb from a human survivor. These mAbs bind overlapping epitopes with a shifted angle. The broad-spectrum potential of c13G8 and CC5-17 and the practicality of using them against Aigai virus, a closely related nairovirus were examined. Binding studies demonstrate that the presence of non-conserved amino acids in Aigai virus corresponding region prevent CCHFV mAbs from binding Aigai virus GP38. This information, coupled with in vivo efficacy, paves the way for future mAb therapeutics effective against a wide swath of CCHFV strains. |
2022 taxonomic update of phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales.
Kuhn JH , Adkins S , Alkhovsky SV , Avi-upanc T , Aylln MA , Bahl J , Balkema-Buschmann A , Ballinger MJ , Bandte M , Beer M , Bejerman N , Bergeron , Biedenkopf N , Bigarr L , Blair CD , Blasdell KR , Bradfute SB , Briese T , Brown PA , Bruggmann R , Buchholz UJ , Buchmeier MJ , Bukreyev A , Burt F , Bttner C , Calisher CH , Candresse T , Carson J , Casas I , Chandran K , Charrel RN , Chiaki Y , Crane A , Crane M , Dacheux L , B ED , delaTorre JC , deLamballerie X , deSouza WM , deSwart RL , Dheilly NM , DiPaola N , DiSerio F , Dietzgen RG , Digiaro M , Drexler JF , Duprex WP , Drrwald R , Easton AJ , Elbeaino T , Ergnay K , Feng G , Feuvrier C , Firth AE , Fooks AR , Formenty PBH , Freitas-Asta J , Gago-Zachert S , Garca ML , Garca-Sastre A , Garrison AR , Godwin SE , Gonzalez JJ , deBellocq JG , Griffiths A , Groschup MH , Gnther S , Hammond J , Hepojoki J , Hierweger MM , Hong S , Horie M , Horikawa H , Hughes HR , Hume AJ , Hyndman TH , Jing D , Jonson GB , Junglen S , Kadono F , Karlin DG , Klempa B , Klingstrm J , Koch MC , Kond H , Koonin EV , Krsov J , Krupovic M , Kubota K , Kuzmin IV , Laenen L , Lambert AJ , L J , Li JM , Lieffrig F , Lukashevich IS , Luo D , Maes P , Marklewitz M , Marshall SH , Marzano SL , McCauley JW , Mirazimi A , Mohr PG , Moody NJG , Morita Y , Morrison RN , Mhlberger E , Naidu R , Natsuaki T , Navarro JA , Neriya Y , Netesov SV , Neumann G , Nowotny N , Ochoa-Corona FM , Palacios G , Pallandre L , Palls V , Papa A , Paraskevopoulou S , Parrish CR , Pauvolid-Corra A , Pawska JT , Prez DR , Pfaff F , Plemper RK , Postler TS , Pozet F , Radoshitzky SR , Ramos-Gonzlez PL , Rehanek M , Resende RO , Reyes CA , Romanowski V , Rubbenstroth D , Rubino L , Rumbou A , Runstadler JA , Rupp M , Sabanadzovic S , Sasaya T , Schmidt-Posthaus H , Schwemmle M , Seuberlich T , Sharpe SR , Shi M , Sironi M , Smither S , Song JW , Spann KM , Spengler JR , Stenglein MD , Takada A , Tesh RB , Tkov J , Thornburg NJ , Tischler ND , Tomitaka Y , Tomonaga K , Tordo N , Tsunekawa K , Turina M , Tzanetakis IE , Vaira AM , vandenHoogen B , Vanmechelen B , Vasilakis N , Verbeek M , vonBargen S , Wada J , Wahl V , Walker PJ , Whitfield AE , Williams JV , Wolf YI , Yamasaki J , Yanagisawa H , Ye G , Zhang YZ , kland AL . Arch Virol 2022 167 (12) 2857-2906 In March 2022, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was amended and emended. The phylum was expanded by two new families (bunyaviral Discoviridae and Tulasviridae), 41 new genera, and 98 new species. Three hundred forty-nine species were renamed and/or moved. The accidentally misspelled names of seven species were corrected. This article presents the updated taxonomy of Negarnaviricota as now accepted by the ICTV. |
Natural Language Processing for Improved Characterization of COVID-19 Symptoms: An Observational Study of 350,000 Patients in a Large Integrated Healthcare System.
Malden DE , Tartof SY , Ackerson BK , Hong V , Skarbinski J , Yau V , Qian L , Fischer H , Shaw S , Caparosa S , Xie F . JMIR Public Health Surveill 2022 8 (12) e41529 BACKGROUND: Natural language processing (NLP) of unstructured text from Electronic Medical Records (EMR) can improve characterization of COVID-19 signs and symptoms, but large-scale studies demonstrating the real-world application and validation of NLP for this purpose are limited. OBJECTIVE: To assess the contribution of NLP when identifying COVID-19 signs and symptoms from EMR. METHODS: This study was conducted in Kaiser Permanente Southern California, a large integrated healthcare system using data from all patients with positive SARS-CoV-2 laboratory tests from March 2020 to May 2021. An NLP algorithm was developed to extract free text from EMR on 12 established signs and symptoms of COVID-19, including fever, cough, headache, fatigue, dyspnea, chills, sore throat, myalgia, anosmia, diarrhea, vomiting/nausea and abdominal pain. The proportion of patients reporting each symptom and the corresponding onset dates were described before and after supplementing structured EMR data with NLP-extracted signs and symptoms. A random sample of 100 chart-reviewed and adjudicated SARS-CoV-2 positive cases were used to validate the algorithm performance. RESULTS: A total of 359,938 patients (mean age: 40.4 years; 53% female) with confirmed SARS-CoV-2 infection were identified over the study period. The most common signs and symptoms identified through NLP-supplemented analyses were cough (61%), fever (52%), myalgia (43%), and headache (40%). The NLP algorithm identified an additional 55,568 (15%) symptomatic cases that were previously defined as asymptomatic using structured data alone. The proportion of additional cases with each selected symptom identified in NLP-supplemented analysis varied across the selected symptoms, from 29% of all records for cough, to 61% of all records with nausea or vomiting. Of 295,305 symptomatic patients, the median time from symptom onset to testing was 3 days using structured data alone, whereas the NLP-algorithm identified signs or symptoms approximately one day earlier. When validated against chart-reviewed cases, the NLP algorithm successfully identified most signs and symptoms with consistently high sensitivity (ranging from 87% to 100%) and specificity (94% to 100%). CONCLUSIONS: These findings demonstrate that NLP can identify and characterize a broad set of COVID-19 signs and symptoms from unstructured data within the EMR, with enhanced detail and timeliness compared with structured data alone. |
Stakeholder Perspectives on the School Experiences of Students With Traumatic Brain Injury: The Effects of COVID-19 Pandemic on Service Delivery.
Unruh D , Gomez D , Slocumb J , McCart M , Davies S , Haarbauer-Krupa J , Glang A . J Sch Health 2022 93 (5) 378-385 BACKGROUND: For students with traumatic brain injury (TBI), the COVID-19 pandemic exacerbated challenges they were already experiencing at school. METHODS: This qualitative study employed focus groups and interviews with students, parents, school, and medical personnel to explore the school experiences of students with TBI. Thematic qualitative analyses were used. RESULTS: Key themes from the analysis include (a) incidence of brain injuries decreased; (b) screen time for students with TBI exacerbated symptoms; (c) COVID protocols at school made it difficult for educators to identify and provide accommodations for students with TBI; (d) COVID protocols at school could inadvertently exacerbate mental health difficulties after a TBI; and (e) COVID-related logistics increased the time between an injury and return to school or return to play. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The results from this study suggest that professional development for teachers supporting students with TBI is needed, especially for online learning environments. Additionally, because mental/behavioral health concerns may arise for students with TBI in online learning environments, school health care providers can work with families to assess a student's mental health, making referrals to appropriate supports. CONCLUSIONS: There is a significant need for professional development and school-wide infrastructure supportive of students with TBI. |
Detection of Airborne Influenza A and SARS-CoV-2 Virus Shedding following Ocular Inoculation of Ferrets.
Belser JA , Sun X , Kieran TJ , Brock N , Pulit-Penaloza JA , Pappas C , BasuThakur P , Jones J , Wentworth DE , Zhou B , Tumpey TM , Maines TR . J Virol 2022 96 (24) e0140322 Despite reports of confirmed human infection following ocular exposure with both influenza A virus (IAV) and SARS-CoV-2, the dynamics of virus spread throughout oculonasal tissues and the relative capacity of virus transmission following ocular inoculation remain poorly understood. Furthermore, the impact of exposure route on subsequent release of airborne viral particles into the air has not been examined previously. To assess this, ferrets were inoculated by the ocular route with A(H1N1)pdm09 and A(H7N9) IAVs and two SARS-CoV-2 (early pandemic Washington/1 and Delta variant) viruses. Virus replication was assessed in both respiratory and ocular specimens, and transmission was evaluated in direct contact or respiratory droplet settings. Viral RNA in aerosols shed by inoculated ferrets was quantified with a two-stage cyclone aerosol sampler (National Institute for Occupational Safety and Health [NIOSH]). All IAV and SARS-CoV-2 viruses mounted a productive and transmissible infection in ferrets following ocular inoculation, with peak viral titers and release of virus-laden aerosols from ferrets indistinguishable from those from ferrets inoculated by previously characterized intranasal inoculation methods. Viral RNA was detected in ferret conjunctival washes from all viruses examined, though infectious virus in this specimen was recovered only following IAV inoculation. Low-dose ocular-only aerosol exposure or inhalation aerosol exposure of ferrets to IAV similarly led to productive infection of ferrets and shedding of aerosolized virus. Viral evolution during infection was comparable between all inoculation routes examined. These data support that both IAV and SARS-CoV-2 can establish a high-titer mammalian infection following ocular exposure that is associated with rapid detection of virus-laden aerosols shed by inoculated animals. IMPORTANCE Documented human infection with influenza viruses and SARS-CoV-2 has been reported among individuals wearing respiratory protection in the absence of eye protection, highlighting the capacity of these respiratory tract-tropic viruses to exploit nonrespiratory routes of exposure to initiate productive infection. However, comprehensive evaluations of how ocular exposure may modulate virus pathogenicity and transmissibility in mammals relative to respiratory exposure are limited and have not investigated multiple virus families side by side. Using the ferret model, we show that ocular exposure with multiple strains of either coronaviruses or influenza A viruses leads to an infection that results in shedding of detectable aerosolized virus from inoculated animals, contributing toward onward transmission of both viruses to susceptible contacts. Collectively, these studies support that the ocular surface represents a susceptible mucosal surface that, if exposed to a sufficient quantity of either virus, permits establishment of an infection which is similarly transmissible as that following respiratory exposure. |
Measurement of microcystin activity in human plasma using immunocapture and protein phosphatase inhibition assay
Cunningham BR , Wharton RE , Lee C , Mojica MA , Krajewski LC , Gordon SC , Schaefer AM , Johnson RC , Hamelin EI . Toxins (Basel) 2022 14 (11) Microcystins are toxic chemicals generated by certain freshwater cyanobacteria. These chemicals can accumulate to dangerous levels during harmful algal blooms. When exposed to microcystins, humans are at risk of hepatic injury, including liver failure. Here, we describe a method to detect microcystins in human plasma by using immunocapture followed by a protein phosphatase inhibition assay. At least 279 microcystins have been identified, and most of these compounds share a common amino acid, the Adda side chain. We targeted this Adda side chain using a commercial antibody and extracted microcystins from human samples for screening and analysis. To quantitate the extracted microcystins, we fortified plasma with microcystin-LR, one of the most well-studied, commonly detected, and toxic microcystin congeners. The quantitation range for the detection of microcystin in human plasma using this method is 0.030-0.50 ng/mL microcystin-LR equivalents. This method detects unconjugated and conjugated forms (cysteine and glutathione) of microcystins. Quality control sample accuracies varied between 98.9% and 114%, with a precision of 7.18-15.8%. Finally, we evaluated plasma samples from a community health surveillance project of Florida residents living or working near harmful algae blooms. |
Single dose topical inserts containing tenofovir alafenamide fumarate and elvitegravir provide pre- and post-exposure protection against vaginal SHIV infection in macaques
Dobard CW , Peet MM , Nishiura K , Holder A , Dinh C , Mitchell J , Khalil G , Pan Y , Singh ON , McCormick TJ , Agrahari V , Gupta P , Jonnalagadda S , Heneine W , Clark MR , García-Lerma JG , Doncel GF . EBioMedicine 2022 86 104361 BACKGROUND: Vaginal products for HIV prevention that can be used on-demand before or after sex may be a preferable option for women with low frequency or unplanned sexual activity or who prefer not to use daily or long-acting pre-exposure prophylaxis (PrEP). We performed dose ranging pharmacokinetics (PK) and efficacy studies of a vaginally applied insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG) in macaques under PrEP or post-exposure prophylaxis (PEP) modalities. METHODS: PK studies were performed in 3 groups of pigtailed macaques receiving inserts with different fixed-dose combinations of TAF and EVG (10/8, 20/16 and 40/24 mg). PrEP and PEP efficacy of a selected insert was investigated in a repeat exposure vaginal SHIV transmission model. Inserts were administered 4 h before (n = 6) or after (n = 6) repeated weekly SHIV exposures. Infection outcome was compared with macaques receiving placebo inserts (n = 12). FINDINGS: Dose ranging studies showed rapid and sustained high drug concentrations in vaginal fluids and tissues across insert formulations with minimal dose proportionality. TAF/EVG (20/16 mg) inserts were selected for efficacy evaluation. Five of the 6 animals receiving these inserts 4 h before and 6/6 animals receiving inserts 4 h after SHIV exposure were protected after 13 challenges (p = 0.0088 and 0.0077 compared to placebo, respectively). The calculated PrEP and PEP efficacy was 91.0% (95% CI = 32.2%-98.8%) and 100% (95% CI = undefined), respectively. INTERPRETATION: Inserts containing TAF/EVG provided high protection against vaginal SHIV infection when administered within a 4 h window before or after SHIV exposure. Our results support the clinical development of TAF/EVG inserts for on-demand PrEP and PEP in women. FUNDING: Funded by CDC intramural funds, an interagency agreement between CDC and USAID (USAID/CDC IAA AID-GH-T-15-00002), and by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under a Cooperative Agreement (AID-OAA-A-14-00010) with CONRAD/Eastern Virginia Medical School. |
Stability of specimens for use in the Centers for Disease Control and Prevention assays for factor VIII and IX inhibitors
Payne AB , Boylan B , Niemeyer G , Werner B , Driggers J , Miller CH , Bean CJ . Res Pract Thromb Haemost 2022 6 (7) The Centers for Disease Control and Prevention (CDC) Nijmegen‐Bethesda Assay (NBA)1 is a modification of traditional methods2., 3. for measurement of factor VIII (FVIII) and factor IX (FIX) inhibitors that includes a 30‐minute preanalytical heat treatment (PHT) step to remove endogenous and infused FVIII or FIX. Specimens for inhibitor tests using PHT thus do not require the stringent conditions needed to maintain clotting factors during shipping and storage, as we have previously documented by split‐sample analysis showing that results of the CDC‐modified NBA on specimens shipped cold correlated well with those of frozen specimens.1 |
Timing and genotype distribution of symptomatic and asymptomatic sapovirus infections and re-infections in a Nicaraguan birth cohort.
González F , Diez-Valcarce M , Reyes Y , Vielot NA , Toval C , Gutiérrez L , Zepeda O , Cuadra EC , Blandón P , Browne H , Bowman NM , Víchez S , Vinjé J , Becker-Dreps S , Bucardo F . Clin Microbiol Infect 2022 29 (4) 540 e9-540 e15 OBJECTIVES: To characterize the timing and genotype distribution of symptomatic and asymptomatic sapovirus infections and re-infections in a Nicaraguan birth cohort. METHODS: Infants (n = 444) were enrolled at 10-14 days of life and followed weekly until 2 years of age. Stool were collected for each acute gastroenteritis (AGE) episode and routine stool were collected monthly. Stools were tested for sapovirus by RT-qPCR and positive samples were genotyped. RESULTS: A total of 348 children completes 2 years of AGE weekly surveillance, 93 (26.7%) of them experienced sapovirus AGE. Most infections occurred after 5 months of age and mainly the second year of life (62.4%, 58/93) and early in the rainy season. Sapovirus screening in all stools from a subset of 67 children, that consistently provided samples, show sapovirus infections in 27.6% (91/330) of the AGE episode and in 2.9% (39/1350) of the routine stool. In this subset, the median age at the first sapovirus AGE was 11.2 month (95%CI; 9.3 - 15.9), 57% (38/67) experienced re-infections, 19 symptomatic and 19 asymptomatic; on average, sapovirus re-infections were reported 7.2 months after symptomatic and 5.3 after asymptomatic infections. Genogroups GI (64%, 69/108) was the most common detected. Sapovirus GI.1 was more frequently detected in AGE than in routine stools (47.2%, 43/91 vs 25.6%, 10/39; p = 0.005) and re-infection with the same genotype was uncommon. CONCLUSION: The first sapovirus infections occurred around 11 months of age, whereas the median time to symptomatic re-infection was 7.2 months. Re-infections with the same sapovirus genotype were rare during 2 years of life suggesting genotype-specific protection following natural infection. |
Profiles of children with cortical visual impairment who use augmentative and alternative communication: A retrospective examination
Blackstone S , Luo F , Barker RM , Sevcik RA , Romski M , Casella V , Roman-Lantzy C . Am J Speech Lang Pathol 2022 31 (6) 2707-2721 PURPOSE: Cortical visual impairment (CVI) is the most common cause of visual impairment in children today and can impact the outcomes of children who rely on augmentative and alternative communication (AAC). This study provides baseline data of 13 children with CVI who used AAC during their first year of participation in an integrated CVI program. One purpose was to describe similarities and differences in the student's demographic, functional vision, communication, and educational profiles. A second purpose was to examine differences in students described with different communicator profiles. METHOD: Archived student records were de-identified and reviewed using a systematic coding scheme. Two researchers independently reviewed and coded all student records. Reliability was established. Measures included CVI Range scores; supports for positioning, mobility, vision, and writing; AAC systems, including modes, access methods, and language representation; communicative competence; self-determination; literacy; and mathematics. RESULTS: The study yielded a rich description of similarities and differences among students at baseline and led to careful consideration of differences among the participants with emergent communicator and context-dependent communicator profiles. CONCLUSIONS: Currently, limited evidence exists that informs practice regarding AAC assessment and intervention for children with CVI. This article describes a small sample of children with CVI who use AAC. Results underscore the need for educators and practitioners to ensure that vision functioning in students with CVI is evaluated carefully and regularly when conducting AAC assessment and intervention and formulating communication or education goals. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21357684. |
Longitudinal changes in various BMI metrics and adiposity in 3- to 7-year-olds
Freedman DS , Woo JG , Daniels SR . Pediatrics 2022 150 (6) BACKGROUND AND OBJECTIVES: Changes in BMI z score (BMIz) are widely used in weight control programs and interventions to monitor changes in body fatness, but this metric may not be optimal. We examined the ability of 3 BMI metrics to assess adiposity change among children with a wide range of BMIs. METHODS: The sample comprised 343 3-year-old children with serial measurements of BMI and body fatness every 4 months over 4 years. We compared correlations between changes in body fatness, calculated with dual-energy-x-ray absorptiometry, and changes in 3 BMI metrics: BMIz and percentage of the 50th (%50th) and 95th (%95th) percentiles in the CDC growth charts. RESULTS: About 21% of the participants were Black and 79% were white. Changes in body fatness over 4 years were more strongly associated with changes in %50th and %95th than with changes in BMIz. Correlations with %body fat among all children were r = 0.64 for BMIz versus r = 0.77 to 0.78 for %50th and %95th (P < .001 for differences between the correlations). Stratified analyses showed the difference between the correlations were similar among boys and girls, among white children and Black children, and among children without obesity and those with obesity. CONCLUSIONS: Changes in adiposity among young children are better captured by expressing changes in BMI as a percentage of the 50th or 95th percentiles instead of BMIz change. Using the best BMI metric will allow pediatricians to better assess a child's change in body fatness over time. |
Evidence and recommendation for mucopolysaccharidosis type II newborn screening in the United States
Ream MA , Lam WKK , Grosse SD , Ojodu J , Jones E , Prosser LA , Rosé AM , Comeau AM , Tanksley S , Powell CM , Kemper AR . Genet Med 2022 25 (2) 100330 Mucopolysaccharidosis type II (MPS II), also known as Hunter syndrome, is an X-linked condition caused by pathogenic variants in the iduronate-2-sulfatase gene. The resulting reduced activity of the enzyme iduronate-2-sulfatase leads to accumulation of glycosaminoglycans that can progressively affect multiple organ systems and impair neurologic development. In 2006, the US Food and Drug Administration approved idursulfase for intravenous enzyme replacement therapy for MPS II. After the data suggesting that early treatment is beneficial became available, 2 states, Illinois and Missouri, implemented MPS II newborn screening. Following a recommendation of the Advisory Committee on Heritable Disorders in Newborns and Children in February 2022, in August 2022, the US Secretary of Health and Human Services added MPS II to the Recommended Uniform Screening Panel, a list of conditions recommended for newborn screening. MPS II was added to the Recommended Uniform Screening Panel after a systematic evidence review reported the accuracy of screening, the benefit of presymptomatic treatment compared with usual case detection, and the feasibility of implementing MPS II newborn screening. This manuscript summarizes the findings of the evidence review that informed the Advisory Committee's decision. |
Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings.
Schulte PA , Delclos GL , Felknor SA , Streit JMK , McDaniel M , Chosewood LC , Newman LS , Bhojani FA , Pana-Cryan R , Swanson NG . Int J Environ Res Public Health 2022 19 (22) There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health(®) concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future. |
Accounting for social workers' emotions during and after the pandemic
Kranke D , Mudoh Y , Dobalian A . Health Soc Work 2022 48 (1) 69-71 The COVID-19 pandemic has increased demand for social workers to provide services for families and communities who experience disparities in health outcomes, healthcare, and education. Generally, social workers are at the forefront of addressing health disparities by providing comprehensive services to the most disadvantaged groups. However, turnover in the profession is a major concern, particularly because of the pandemic. The annual rate of turnover among social workers nationwide during nonpandemic times is 30 percent, with some agencies reporting as much as 65 percent (Chang, 2017). Moreover, there is a shortage of social workers despite the projected need over the next 10 years for growth of 13 percent (U.S. Bureau of Labor Statistics, 2020). These growth figures may be premature, as the number of social workers leaving the field may rise because of added stress caused by the pandemic. |
Multi-instrument assessment of fine and ultrafine titanium dioxide aerosols
Ranpara A , LeBouf RF , Nurkiewicz TR , Yi J , Cumpston JL , Stefaniak AB . J Toxicol Environ Health A 2022 86 (1) 1-22 The measurement of fine (diameter: 100 nanometers-2.5 micrometers) and ultrafine (UF: < 100 nanometers) titanium dioxide (TiO(2)) particles is instrument dependent. Differences in measurements exist between toxicological and field investigations for the same exposure metric such as mass, number, or surface area because of variations in instruments used, operating parameters, or particle-size measurement ranges. Without appropriate comparison, instrument measurements create a disconnect between toxicological and field investigations for a given exposure metric. Our objective was to compare a variety of instruments including multiple metrics including mass, number, and surface area (SA) concentrations for assessing different concentrations of separately aerosolized fine and UF TiO(2) particles. The instruments studied were (1) DustTrak™ DRX, (2) personal DataRAMs™ (PDR), (3) GRIMM(TM), and (4) diffusion charger (DC). Two devices of each field-study instrument (DRX, PDR, GRIMM, and DC) were used to measure various metrics while adjusting for gravimetric mass concentrations of fine and UF TiO(2) particles in controlled chamber tests. An analysis of variance (ANOVA) was used to apportion the variance to inter-instrument (between different instrument-types), inter-device (within instrument), and intra-device components. Performance of each instrument-device was calculated using root mean squared error compared to reference methods: close-faced cassette and gravimetric analysis for mass and scanning mobility particle sizer (SMPS) real-time monitoring for number and SA concentrations. Generally, inter-instrument variability accounted for the greatest (62.6% or more) source of variance for mass, and SA-based concentrations of fine and UF TiO(2) particles. However, higher intra-device variability (53.7%) was observed for number concentrations measurements with fine particles compared to inter-instrument variability (40.8%). Inter-device variance range(0.5-5.5%) was similar for all exposure metrics. DRX performed better in measuring mass closer to gravimetric than PDRs for fine and UF TiO(2). Number concentrations measured by GRIMMs and SA measurements by DCs were considerably (40.8-86.9%) different from the reference (SMPS) method for comparable size ranges of fine and UF TiO(2). This information may serve to aid in interpreting assessments in risk models, epidemiologic studies, and development of occupational exposure limits, relating to health effect endpoints identified in toxicological studies considering similar instruments evaluated in this study. |
A review of occupational safety and health research for American Indians and Alaska Natives
Wingate K , Dalsey E , Scott DP . J Safety Res 2022 84 204-211 Introduction: To better understand what is known about issues affecting American Indian and Alaska Native (AI/AN) workers, authors conducted a literature review of publications specific to AI/AN and occupational safety and health. Methods: Search criteria included: (a) American Indian tribes and Alaska Native villages in the United States; (b) First Nations and aboriginals in Canada; and (c) occupational safety and health. Results: Results of two identical searches in 2017 and 2019 identified 119 articles and 26 articles respectively, with references to AI/AN people and occupation. Of the 145 total articles, only 11 articles met the search criteria for addressing occupational safety and health research among AI/AN workers. Information from each article was abstracted and categorized according to National Occupational Research Agenda (NORA) sector, resulting in: four articles related to agriculture, forestry, and fishing; three related to mining; one related to manufacturing; and one related to services. Two articles reported on AI/AN people and occupational well-being in general. Conclusions: The review was limited by the small number and age of relevant articles, reflecting the likelihood that findings could be out of date. General themes across the reviewed articles point to the need for increased overall awareness and education regarding injury prevention and risks associated with occupational injuries and fatalities among AI/AN workers. Similarly, increased use of personal protective equipment (PPE) is recommended for the agriculture, forestry, and fishing industries, as well as for workers exposed to metals dust. Practical Applications: The lack of research in most NORA sectors indicates the need for heightened research efforts directed toward AI/AN workers. © 2022 |
Psychosocial risk factors for low back pain in US workers: Data from the 2002-2018 quality of work life survey
Yang H , Lu ML , Haldeman S , Swanson N . Am J Ind Med 2022 66 (1) 41-53 BACKGROUND: Examining workplace psychosocial risk factors for back pain becomes increasingly important because of the changing nature of work and rising healthcare costs. Some psychosocial risk factors for back pain, such as work and family imbalance, exposure to a hostile work environment, and job insecurity, are understudied for the working population in the United States. METHODS: Data used in this study came from the Quality of Work Life Survey (QWL), a supplementary module of the General Social Survey conducted in the United States. Data from the 2002, 2006, 2010, 2014, and 2018 QWL surveys were used in these analyses, giving a total sample size of 6661. Five domains of workplace psychosocial risk factors for back pain were examined, including job strain, low social support, work-family imbalance, exposure to a hostile work environment (harassment and discrimination), and job insecurity. The adjusted odds ratio (aOR) of each psychosocial risk factor for back pain with 95% confidence intervals (CI) was estimated using a multivariable logistic regression model after controlling for job physical factors, occupation, and demographic and socioeconomic characteristics. RESULTS: Significant associations were found between back pain and several psychosocial factors including job strain (aOR 1.19; CI 1.00,1.41), work-family imbalance (aOR,1.42; CI 1.22,1.64), harassment (aOR 1.40; CI 1.15,1.71), and discrimination (aOR 1.20 CI 1.00,1.44). CONCLUSION: This study contributes to the understanding of the relationship between a variety of workplace psychosocial factors and back pain. Our findings suggest directions in future longitudinal research to examine emerging workplace psychosocial factors for back pain. |
MaHPIC malaria systems biology data from Plasmodium cynomolgi sporozoite longitudinal infections in macaques.
DeBarry JD , Nural MV , Pakala SB , Nayak V , Warrenfeltz S , Humphrey J , Lapp SA , Cabrera-Mora M , Brito CFA , Jiang J , Saney CL , Hankus A , Stealey HM , DeBarry MB , Lackman N , Legall N , Lee K , Tang Y , Gupta A , Trippe ED , Bridger RR , Weatherly DB , Peterson MS , Jiang X , Tran V , Uppal K , Fonseca LL , Joyner CJ , Karpuzoglu E , Cordy RJ , Meyer EVS , Wells LL , Ory DS , Lee FE , Tirouvanziam R , Gutiérrez JB , Ibegbu C , Lamb TJ , Pohl J , Pruett ST , Jones DP , Styczynski MP , Voit EO , Moreno A , Galinski MR , Kissinger JC . Sci Data 2022 9 (1) 722 Plasmodium cynomolgi causes zoonotic malarial infections in Southeast Asia and this parasite species is important as a model for Plasmodium vivax and Plasmodium ovale. Each of these species produces hypnozoites in the liver, which can cause relapsing infections in the blood. Here we present methods and data generated from iterative longitudinal systems biology infection experiments designed and performed by the Malaria Host-Pathogen Interaction Center (MaHPIC) to delve deeper into the biology, pathogenesis, and immune responses of P. cynomolgi in the Macaca mulatta host. Infections were initiated by sporozoite inoculation. Blood and bone marrow samples were collected at defined timepoints for biological and computational experiments and integrative analyses revolving around primary illness, relapse illness, and subsequent disease and immune response patterns. Parasitological, clinical, haematological, immune response, and -omic datasets (transcriptomics, proteomics, metabolomics, and lipidomics) including metadata and computational results have been deposited in public repositories. The scope and depth of these datasets are unprecedented in studies of malaria, and they are projected to be a F.A.I.R., reliable data resource for decades. |
Maintaining our commitment to building scientific publishing capacity of students: PCD's 2022 student paper contest winners and release of 2023 call for papers
Jack LJr . Prev Chronic Dis 2022 19 E73 Preventing Chronic Disease (PCD) initiated its first Student Paper Contest in 2011 (1). Since that time, the journal has received hundreds of student research papers from around the world. Last year, PCD celebrated its 10-year anniversary of building scientific publishing skills and abilities among students (2). Research mentors have used this journal as an avenue to introduce their students to the rigors of generating scholarly writings that focus on conceptualizing research; collecting, analyzing, and reporting data; and discussing the public health implications of research findings. Since 2011, regardless of whether papers are accepted, PCD has provided students with extensive feedback on their submissions. |
Changes in home births by race and hispanic origin and state of residence of mother: United States, 2019-2020 and 2020- 2021
Gregory EC , Osterman MJ , Valenzuela CP . Natl Vital Stat Rep 2022 71 (8) 1-10 Objectives-This report describes changes between 2020 and 2021 in the percentage of home births by month, race and Hispanic origin, and state of residence of the mother, and makes comparisons with changes occurring between 2019 and 2020. |
Crush: A randomized trial to evaluate the impact of a mobile health app on adolescent sexual health
Martnez-Garca G , Ewing AC , Olugbade Y , DiClemente RJ , Kourtis AP . J Adolesc Health 2022 72 (2) 287-294 PURPOSE: Mobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents. METHODS: We recruited 1,210 women aged 14-18years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience. RESULTS: There was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR]= 1.6, 95% confidence interval [CI]: 1.1-2.3) and of believing that it is a good thing to use birth control consistently (aOR= 2.3, 95% CI: 1.4-3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR= 1.8, 95% CI: 1.2-2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1-2.2). Impacts on other behavioral constructs were also found. DISCUSSION: Crush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts. |
Content Index (Achived Edition)
- Communicable Diseases
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- Disease Reservoirs and Vectors
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